Select Program ***Everyone must bring their own basketball!***
__ Private Lessons __ Private Group Lessons
__ Shooting School __ Free Clinic
__ Camp
Dates of attendance __/__ - __/__
Select Location
__FIU __FAU __Scott Rakow Cntr. __ North Shore Cntr.
__ Sugar Sand Park __ Key Biscayne
__ Sunset Lakes Cntr. __Other ___________
$_______.00 Payment Enclosed
Please mail signed registration form with check payable to One on One Basketball Inc. Mail to:
One on One Basketball Academy
P.O. Box 801141
Aventura, FL 33280-1141
Player Name _______________________ Age ____ Grade ____ School ____________________
Parent/Guardian______________________________/______________________________
Home Phone:_____ - _____-____________ Cel:_____-_____-____________
Email(Very Important) ___________________________________________
Street _________________________ City _________________________ Zip____________
Consent and Release: I acknowledge the risks and hazards, both known and unknown, associated
with my child's participation in One on One Basketball Inc. activities, and recognize, accept, and assume responsibility,
and give consent/permssion for my child to participate fully, and to be rendered emergency medical treatment in the event
of injury or illness, and agree to be responsible for all costs associated with my child's transportation and treatment. I
understand that One on One Basketball Inc. it's director, staff, coaches, employees, and agents, including those facilities
hosting One on One Basketball Inc. training, are hereby relieved of any and all responsibility and liability, and cannot assume
responsibility for acts and ommissions of third parties that are called to render treatment. I also give my consent and release
all rights for One on One Basketball Inc. to take and use comments, likeness, photographs and/or video, of myself and of my
son/daughter, to be used for publicity and promotion, in any and all forms of media, including brochures, websites, newspapers,
and video/TV broadcasts. NO REFUNDS - for any reason - payment may be used to participate in another One on One Basketball
Inc. program. My signature represents that I agree to all terms, conditions and payments, as stated on this form, and that
my child is currently covered by medical insurance. ***Everyone must bring their own basketball!***
Signature of Parent/Guardian ___________________________________________
Print Name _________________________________________________________
Date: _____/_____/_____
